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Typical Treatment of Chronic Lymphocytic Leukemia<br />Treatment options for chronic lymphocytic leukemia (CLL) can vary greatly.<br /><br />Many people live a long time with CLL, but in general it is very hard to cure, and early treatment hasn&#039;t been shown to help people live longer. Because of this and because treatment can cause side effects, doctors often advise waiting until the disease is progressing or bothersome symptoms appear, before starting treatment.<br /><br />If treatment is needed, factors that should be taken into account include the patient’s age and overall health, and prognostic factors such as the presence of deletions in chromosomes 17 or 11, or high levels of ZAP-70 and CD38.<br /><br />Initial treatment of CLL<br />Drugs that may be used<br />Many different drugs and drug combinations can be used as the first treatment for CLL. The options include monoclonal antibodies, other targeted drugs, chemotherapy, and different combinations of these. <br /><br />Some of the more commonly used treatments include:<br /><br />Ibrutinib (Imbruvica), alone or with rituximab (Rituxan)<br />Acalabrutinib (Calquence), alone or with obinutuzumab (Gazyva)<br />Venetoclax (Venclexta) and obinutuzumab <br />Venetoclax alone, or with rituximab<br />Bendamustine and rituximab (or another monoclonal antibody)<br />High-dose prednisone and rituximab<br />FCR: fludarabine, cyclophosphamide, and rituximab<br />PCR: pentostatin, cyclophosphamide, and rituximab<br />Chlorambucil and rituximab (or another monoclonal antibody)<br />Obinutuzumab<br />Ibrutinib and obinutuzumab<br />Alemtuzumab (Campath), alone or with rituximab<br />Other drugs or combinations of drugs may also be used.<br /><br />Radiation or surgery<br />If the only problem is an enlarged spleen or swollen lymph nodes in one part of the body, localized treatment with low-dose radiation therapy may be used. Splenectomy (surgery to remove the spleen) is another option if the enlarged spleen is causing symptoms.<br /><br />Leukapheresis<br />Sometimes very high numbers of CLL cells in the blood cause problems with normal circulation. This is called leukostasis. Chemo may not lower the number of cells until a few days after the first dose, so before the chemo is given, some of the cells may need to be removed from the blood with a procedure called leukapheresis. This treatment lowers blood counts right away. The effect lasts only for a short time, but it may help until the chemo has a chance to work. Leukapheresis is also sometimes used before chemo if there are very high numbers of leukemia cells (even when they aren’t causing problems) to prevent tumor lysis syndrome. (This was discussed in the chemotherapy section.)<br /><br />Stem cell transplant<br />Some people who have very high-risk disease (based on prognostic factors ) may be referred for possible stem cell transplant (SCT) early in treatment.<br /><br />Second-line treatment of CLL<br />If the initial treatment is no longer working or the disease comes back, another type of treatment often helps. If the initial response to the treatment lasted a long time (usually at least a few years), the same treatment migh

What Is Chronic Lymphocytic Leukemia?<br />Cancer starts when cells start to grow out of control. Cells in nearly any part of the body can become cancer and can spread to other parts of the body. To learn more about how cancers start and spread, see What Is Cancer?<br /><br />Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults. It&#039;s a type of cancer that starts in cells that become certain white blood cells (called lymphocytes) in the bone marrow. The cancer (leukemia) cells start in the bone marrow but then go into the blood.<br /><br />In CLL, the leukemia cells often build up slowly. Many people don&#039;t have any symptoms for at least a few years. But over time, the cells grow and spread to other parts of the body, including the lymph nodes, liver, and spleen.<br /><br />What is leukemia?<br />Leukemia is cancer that starts in the blood-forming cells of the bone marrow. When one of these cells changes and becomes a leukemia cell, it no longer matures the way it should and grows out of control. Often, it divides to make new cells faster than normal. Leukemia cells also don&#039;t die when they should. This allows them to build up in the bone marrow, crowding out normal cells. At some point, leukemia cells leave the bone marrow and spill into the bloodstream. This increases the number of white blood cells in the blood. Once in the blood, leukemia cells can spread to other organs, where they can prevent other cells in the body from functioning normally.<br /><br />Leukemia is different from other types of cancer that start in organs like the lungs, colon, or breast and then spread to the bone marrow. Cancers that start elsewhere and then spread to the bone marrow are not leukemia.<br /><br />Knowing the exact type of leukemia helps doctors better predict each patient&#039;s outlook and select the best treatment.<br /><br />What is a chronic leukemia?<br />In chronic leukemia, the cells can mature partly (and more are like normal white blood cells). but not completely. These cells may look fairly normal, but they&#039;re not. They generally don&#039;t fight infection as well as normal white blood cells do. The leukemia cells survive longer than normal cells, and build up, crowding out normal cells in the bone marrow. It can take a long time before chronic leukemias cause problems, and most people can live with them for many years. But chronic leukemias tend to be harder to cure than acute leukemias.<br /><br />What is a lymphocytic leukemia?<br />Leukemia is myeloid or lymphocytic depending on which bone marrow cells the cancer starts in.<br /><br />Lymphocytic leukemias (also known as lymphoid or lymphoblastic leukemia) start in the cells that become lymphocytes. Lymphomas are also cancers that start in those cells. The main difference between lymphocytic leukemias and lymphomas is that in leukemia, the cancer cells are mainly in the bone marrow and blood, while in lymphoma they tend to be in lymph nodes and other tissues.<br /><br />Different types of CLL<br />Doctors agree that there seem to be 2 different kinds of CLL:<br /><br />One kind of CLL grows very slowly. So